While your first instinct might be to give unlimited hay and even grain to horses with low body scores, your good intentions could actually be fatal.

When dealing with a starved horse, how should you feed him? How much, how often, and what type of feed will bring the horse back to good health without causing more problems?

The starved horse is in a most delicate health predicament, and returning him to health requires using proper "refeeding" protocols. However, a starved horse should undergo a thorough veterinary examination to determine that there is no underlying medical reason for the weight loss.

The first 10 days of addressing a starved horse are critical in helping him transition to a fed state, according to Carolyn Stull, MS, PhD, an animal welfare specialist at the University of California, Davis. Stull has conducted extensive research on refeeding starved horses and has found that starting starved horses on alfalfa or alfalfa mix hay is the best plan of action due to the high composition of quality protein, as well as major electrolytes, phosphorus, and magnesium found in these hays. Stull says the best approach for initial refeeding consists of frequent small amounts of high-quality alfalfa. The amount should be increased slowly at each meal, and the number of feedings decreased over 10 days. After 10 days to two weeks, horses can be fed as much hay as they will eat.

Severely starved horses should not receive concentrates for the first few weeks, Stull advises.

Refeeding Syndrome

The delicate nature of refeeding starved horses is a day-to-day process. Stull says she receives many calls from veterinarians and rescue groups asking about the protocol and how to avoid medical problems. She warns against refeeding too much, too soon, because it can kill a horse.

When refeeding a starved horse it is imperative to avoid refeeding syndrome, which can occur when a horse is fed too many calories too quickly. This can lead to heart, respiratory, and kidney failure three to five days after feeding commences, according to Amy M. Gill, PhD, an equine nutritionist in Lexington, Ky.

"These medical issues are a result of electrolyte imbalances that are caused by the sudden reintroduction of soluble carbohydrates and other nutrients into the body, which in turn causes a shift in hormones involved in normal metabolism and causes a drop in the electrolyte concentration in the blood," she says.

Surviving Starvation

A starved horse is in jeopardy of dying when it has lost most of its body fat and the body begins to consume muscle. Jennifer Williams, MS, PhD, founder, president, and executive director of Bluebonnet Equine Humane Society in College Station, Texas, says she usually has a good idea of the outcome when she sees horses that are in the worst physical shape. "You can see their individual vertebrae and hip bones," she says. "Those horses can survive, but when I see them, I reserve judgment."

Like Stull, Williams believes the initial period of care is critical--she considers this time to be about two weeks. "If they can make it past that, generally they seem to make a full recovery," Williams says.

It is more difficult for extremely skinny horses to recover as they are more susceptible to myriad problems, including organ failure. If that occurs, she says they have to euthanize the horse because there is no hope for recovery or long-term survival.

"With starving horses you can never guess which ones are going to survive and which ones aren't," Stull says. "It's always a sad situation, but it's something that at least we have some sort of protocol we can attempt to initiate with them. In that sense it's a positive thing."

Other Steps in Rehabilitation

Forage and water are not the only ways to bring a starved horse back to health. Williams, for instance, is hands-on with her foster cases from day one. She spends time with the horses, even if only for five to 10 minutes, twice a day at, or closely before, feeding time. She pets them and she leads them out to pasture and brings them back inside.

She avoids brushing the extremely skinny horses, but she has their hooves trimmed immediately if they are overgrown to the point of being painful. Otherwise, she will work the horses into a regular farrier schedule.

She typically starts working starved horses only when they get to a body condition score of 3 or 3.5 (see TheHorse.com/pdf/nutrition/bcsposter.pdf for a guide to body condition score). "I'll lunge them for five to 10 minutes or hand walk them from once to three times a week," she says. "I want to start building some muscle, but I want them well on their way to gaining weight."

Stull says grooming and TLC bring a lot to the equation. "All the extra care probably pays off in ways we don't know about," she admits.

Along with the direct approach of a proper refeeding program, good nursing pays off, she adds.

It typically takes a couple of months before a starved horse is totally rehabilitated if nothing goes wrong during the process, says Sarah Ralston, VMD, PhD, Dipl. ACVN, an associate professor in the Department of Animal Sciences at Rutgers University in New Jersey. "Be patient when refeeding them," she advises. "They can survive at these low body condition scores, but the biggest error I've seen people do is push them too fast to gain weight."

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